Caring For Clients With Immune System Problems (HS 3rd Ed. Chap 18) PDF

Caring for Clients with Problems in the Immune System (HS 3rd Ed. Chapt 18) Dr. Kobayashi First Line of Defense Obj. 1 Skin ________________________ ______________________ Cilia in bronchi  Lymphatic System Lymph Nodes: Acquired immune respo...

Caring for Clients with Problems in the Immune System (HS 3rd Ed. Chapt 18) Dr. Kobayashi First Line of Defense Obj. 1 Skin ________________________ ______________________ Cilia in bronchi  Lymphatic System Lymph Nodes: Acquired immune response activation Interaction between APC + T helper cells Activation of lymphocytes Lymphatic circulation: Gravity, muscle movements, from distal to central direction (valved)  Overview of the Immune System Innate Immunity Neutrophils, macrophages, NK Antigen cells non- specific Immune Response B cells Plasma cells (Antibody) Antigen Humoral Immunity specific Acquired (adaptive) T helper cells + Antigen presenting cells Immunity Cell-mediated Immunity Effector (CD 8) T cells CTL (IFN-g) 4  Innate Immunity (Objective 2.1) At Birth __________________: only recognizes different antigens from self (self and non-self) Very quick response (within minutes) WBC in innate immunity _________________________ Macrophages (___________________) NK cells Hematopoiesis (Obj. 2-3) Acquired Immunity: Lymphocytes Objective 3 Developed after birth Antigen specific : One lymphocyte recognizes one protein or one infectious pathogen (non-self) Needs time to develop (a few days) Interaction between T helper cell and APC Future memory (remembers years) Memory cells (secondary response): Stronger, faster and longer response at the second time  Acquired Immunity: Lymphocytes 2 major functions –Humoral immunity –Cell-mediated immunity  Humoral Immunity Obj. 4-2 B cells (B lymphocytes): Born and educated in bone marrow B cells recognize antigen by BCR (antibody) B lymphocytes + antigen + messengers from T(h) cells → plasma cells & memory B cells Plasma cells secrete antibodies (Ig) Antibody:  Antibody Fab Complement Fc binding site Antibody (Immunoglobulin: Ig) Obj. 4-1 Classes (Types) of Ig IgM (on B cells, complement activation) IgG (circulating in blood) IgA (mucous membrane) IgE(allergic responses) IgD  Antigen/Antibody Reactions Neutralization: block microbes from infecting host cells (IgG, IgA) Agglutination: crosslink the antigen: cells, bacteria (IgM, IgG) Opsonization: microbe + Fc of Ig = phagocytosis Complement proteins: Approx. 20 plasma proteins: Work together with cascade effect to fight bacterial infection  Cell-Mediated Immunity Obj. 4- 2 T cells (born in BM, educated in Thymus) T cells recognize antigens only when presented in MHC of APC (nucleated cells) Become effector/killer T cells (CTL: to kill target cells) or memory cells 2 types of T cells – CD4 T cells = helping other immune cells – CD8 T cells = kill infected or cancer cells  MHC (Cell Surface Markers) Obj. 3 T cells recognize antigens only when presented in MHC (major histocompatibility complex) HLA (human leukocyte antigens) MHC class I: expressed in all nucleated cells MHC molecules are unique to each person (like fingerprint) Life Span of Blood Cells RBC 120 days (4 months) Platelets 7-8 days Neutrophils up to 12 hours Monocytes/ 3 days Macrophage Other Factors in Immune Responses (Objective 4.4) Cytokines Chemokines  Cytokines: Interleukins (IL)  macrophages & neutrophils  antibody responses  differentiation of lymphocytes Can be called immune cell growth factors Associated with fever & sleep (causes malaise)  Cytokines: Interferon Anti-viral Anti-tumor Facilitates lysis by macrophages and killer cells May inhibit proliferation of lymophocytes Application of Immune Responses Vaccinations  Vaccinations (Objective 2.2) Active (activate acquired response: Ab, CTL) – Killed pathogens: typhoid – Attenuated (live, nonvirulent): smallpox – mRNA or DNA (COVID vaccines) – Need time to develop – Will develop memory  Vaccinations Passive (does NOT activate acquired response) – Receives antibodies (Ig: globulins) – Immediate effect – Short duration (weeks to months) – No memory – Example Tetanus immune globulins Chicken pox antibodies from mom Gammagard (IV-Ig: intravenous immunoglobulin)  Vaccinations Nursing – Do not give if  temp – Common response: Fever, erythema, edema, malaise (24h) – Advise Tylenol & fluids – Watch for allergic reactions  New Theory re: Aging Immune System Objective 7 Life-long exposure to persistent (latent) infections like HSV and varicella cause need for continuous immunosurveillance. Thymus degeneration: ↓Proportion of antigen-naïve T cells and eventually not enough naïve T cells to respond to new antigens ↓ number of memory T and B cells Leads to ↓ vaccination response and infection – Chettle, C. (2009) Aging immune systems more vulnerable to attack. NurseWeek. 22(6), 20-23  Obj. 6 to 9 Assessment: see text Standard Precautions: Policy on Exposure to Blood and/or body fluids (Student Handbook)  Review: Immune Response 1. What are important characteristics of acquired immunity? 2. What are the main cell types in acquired immune responses? 3. Describe the structure of an antibody 4. Name some of the antigen-antibody responses. 5. Name some of the messengers involved in immune responses? 6. Name some of the WBCs (differentials). 7. How do T cells recognize antigens? 8. Nursing care related to vaccine 9. What immune responses recognize self vs non- self? 25  Cytokines: Colony Stimulating Factors (CSF) & other GF Stimulates bone marrow to  ______, RBC, platelets – G-CSF (_________________) – GM-CSF (Monocytes) – Erythropoietin (____________) – Thrombopoietin (platelets)